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PDAT1 > 4 - Nausea / Vomiting > Flashcards

4 - Nausea / Vomiting Flashcards

1
Q

Emetrol

Phosphorylated Carbohydrate Solution

Dose / Indication

Fructose, dextrose, orthophosphoric acid

A

ANTIEMETIC

upset stomach / food indiscretions / emotional upset

Adults:

15-30ml q15min

(1-2 Tablespoons), until nausea subsides

Max 5 doses in 1 hour, no longer than 1 hour

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2
Q

Emetrol

Consultation

Fructose, dextrose, orthophosphoric acid

A
  • Do not Dilute solution or Drink Fluids prior to use*
  • Wait 15 minutes prior to last dose*
  • DNT for more than 1 hour (5 doses)*

not for children or newborns

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3
Q

Emetrol

Adverse Effects

Phosphorylated Carbohydrates

A

Abdominal Cramping

Diarrhea

15-30ml q15

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4
Q

Emetrol

CI’s & Precautions

Phosphorylated Carbohydrates

A
  • DNU in newborns / children unless DR*
  • DNU w/ Diabetics high SUGAR content*
  • DNU w/ Hereditary fructose intolerance (HFI)*
  • <5 doses in 1 hour*

15-30ml q15min

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5
Q

Bonine / Meclizine

Indication

A

Motion Sickness Medication

chewable / 25mg tablets

Treats & prevents adults w/

Nausea / Dizziness / Vomiting

(associated w/ motion sickness)

1-2t QD, 1 hr before activity

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6
Q

Meclizine / Cyclizine

Bonine

Dose

A

1-2 Tablets (25-50mg) QD

1 Hour before

engaging in activity that causes motion sickness

Can be CHEWED OR SWALLOWED

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7
Q

Bonine / Meclizine

Consultation

A

Drowsiness

Avoid Alcohol / alertness needed in activities

Clear View

PMH: Asthma / Glaucoma / BPH

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8
Q

BONINE / Meclizine / Cyclizine​

Adverse Effects

A

Drowsiness

Dry Mouth

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9
Q

BONINE / Meclizine / Cyclizine

CI’s + PC’s

A

Paradoxical Stimulatory in children

  • DNU in children <12 y/o*
  • DNU in pt w/ PMH of BPH/asthma/urination issue/glaucoma*

CNS Depression - Alcohol / depressants

PCAT - B

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10
Q

DRAMAMINE

dimenhydrinite / meclizine / ginger

Indication

A

Motion Sickness Medication

Relief of Nausea / Dizziness / Vomiting (MS symptoms)

50Tab / Chewable / Kids 25mg

1-2t (50-100mg) q46 or 30min b4

max 8tab in 24 hrs

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11
Q

Meclizine Vs Other MS medications

A

Meclizine may be LESS SEDATING

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12
Q

DRAMAMINE

dimenhydrinite / meclizine / ginger

DOSE

A

1-2tabs (50-100mg) Q46

or

30 minutes b4 activity

Max 8 Tabs (400mg) in 24 hours

less drowsy formulation only for adults, 2 tabs max

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13
Q

DRAMAMINE

dimenhydrinite / meclizine / ginger

Consultation

A

Same As Bonine/meclizine

Drowsiness

Avoid Alcohol / alertness needed in activities

Clear View

PMH: Asthma / Glaucoma / BPH

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14
Q

DRAMAMINE

dimenhydrinite / meclizine / ginger

AE’s

A

Same as Bonine / meclizine

Drowsiness

Dry Mouth

ANTICHOLINERGIC

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15
Q

DRAMAMINE

dimenhydrinite / meclizine / ginger

CI’s + PC’s

A

Similar to Bonine

Paradoxical Stimulatory in children

DNU for children <2 y/o

(vs 12 y/o with meclizine)

CNS depression - alcohol + CNS depressants

PMH of asthma / glaucoma / BPH

PC - B

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16
Q

Symptoms of NV

A

Nausea

feeling of needing to vomit

Retching

involuntary diaphragm/ab contractions

Vomiting

Rapid/forceful expulsion of GI tract contents

17
Q

Types of N/V

A

Motion Sickness

NVP (pregnancy)

Overeating / eating disagreable foods

Food Poisoning / Viral Gastroenteritis

Medication Use

Episodic / Situational NV

18
Q

Complications of NV

A

Dehydration

Electrolyte / A-B Imbalance

Esophageal Tears

Aspiration / Malnutrition

Diaphragmatic HERNIATION

Mallory-Weiss Syndrome

19
Q

Exclusions for Self-Treatment (EX-S-T)

N/V

A

Head Injury

Urine Ketones / High BG

Food poisoning >24 hours

ab pain in mid or right lower quadrent

BLOOD in vomitus

Yellow skin/eye

Dark Urine

STIFF NECK

20
Q

EX-ST

NV for CHILDREN

A

Severe DEHYDRATION

caregiver unable/willing to manage at home

21
Q

Motion Sickness Facts

A

Better to PREVENT vs treating

rare in kids <2 y/o, more common in WOMEN

Overstimulation of Labrinth apparatus

fluid in canal moves -> postural adjustment / 2 axis

-> unusual motion patterns

22
Q

Motion Sickness Treatment

A

Antihistamines: Meclizine / Cyclizine / Dimenhydrinate

Bonine / Dramamine

Meclizine may be less sedating

23
Q

Motion Sickness Prevention

A
  • Avoid Reading during Travel*
  • Avoid excess Food / Alcohol before&during travel*

Focus on the line of vision fairly straight ahead

avoid Strong odors

Drive vehicle

24
Q

N/V in PREGNANCY

A

50-80% in EARLY pregnancy

subsides by 20th week in 80% of women

MultiFactoral

Accupressure

GINGER

25
Q

NVP Treatment

A

Diclegis (Pyridoxine + Doxylamine) Extended Release

RX ONLY

Pyridoxine 10-25mg TID +/- Doxylamine 10mg TID

This is OTC

Doxylamine / dimenhydrinate effective

but not a lot known about fetal outcomes​

26
Q

Preventing NVP

A

Fresh Air

Dry crackers 10-15 min b4 getting out of bed (slowly)

4-5 small meals, do not overeat

Avoid Fluids or Soups at meals

When nauseated, sip co2 beverages / fruit juice

avoid greasy / spicy / fatty / acidic foods

Eat Dry / Bland / High-protein foods / Chilled

27
Q

Overeating & Treatment

A

Gut Distention + Decreased GI emptying

–> Stimulation of mechanoreceptors

Emetrol - 15-30ml q15

(phosphorlated carb solution)

(HYPERosmolar)

acts on GI to decrease smooth muscle contraction

delay gastric emptying time

28
Q

Acute Viral Gastroenteritis

A

Inflammation of stomach / SI

Presents w/ Acute Vomiting + Diarrhea

Self-limiting - Gone after 24 Hours

can be serious with children due to dehydration

29
Q

S/S of DEHYDRATION

in children

A

Sunken Eyes / Fontanelle

Dry eyes, Decreased skin tugor

Dark /little Urine

Absence of tears

Weight LOSS (small abdominal size)

Lethargy / sleepiness / decreased alertness / Irritability

difficulty waking child / lightheaded

30
Q

Treatment for Dehydration

A

ORS (oral rehydration therapy)

Glucose Based ORS (gatorade)

more ISOMOLAR, more effective at rehydrating vs water

Fluid absorption may be COMPRIMISED in pts with:

continuous vomiting > more difficult than diarrhea

31
Q

ORT Ideal Osmolarity

A

245

(mOs m/L)

WHO-ORS

Pedialyte = 249

Gatorade = 330 (lot of sugar)

32
Q

Gatorade as ORT

A

OSM = 330 (close to 245)

But a lot of SUGAR

too much sugar -> DRY in GI tract

ultimately want Sugar:Sodium ratio of 3:1

33
Q

ORT for Minimal Dehydration

A

Children <10kg: 60-120ml

after each vomiting episode

Children >10kg: 120-240ml

after “

if severe _REFER to ED for IV fluid replacement_

34
Q

ORT for Mild-Moderate Dehydration

A

Children:

50-100ml/kg

OVER 3-4 hours

Weight based, over 3-4 hours

if severe REFER to ED for IV fluid replacement

35
Q

ORT for ADULTS

A

replace

30-50% of fluids lost

in first 24 hours

mainly gauge how you feel

drink ORS

36
Q

Pedialyte Freezer Pops

A

Taste much better when COLD

Offered 10 min after last episode of vomiting

5ml q5min for children

15ml q5min for older children / adults

37
Q

Complementary Therapy

for NV

A

Ginger

250mg (root) po QID for NVP / MS / Surgery

Accupressure

P6 point on wrist, wristband 10min TID or continuously

Aromatherapy

Peppermint Oil / Isopropyl Alcohol

38
Q

Determining Dehydration in Children

A

Weight loss / Decrease in abdominal size

<3% (minimal),

3-9% (mild-moderate),

>9% (severe)

39
Q

OTC NVP Treatment

& Dose

A

Pyridoxine 10-25mg TID

with or without

Doxylamine 10mg TID

This is OTC

PDAT1 (27 decks)

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